Thomas Test: Hip to Be Square Part II

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Yesterday I went into a little detail on the Thomas Test and how it can be a very effective test to assess hip flexor length. Unfortunately, while it’s a fairly idiot proof test to administer, many fitness professionals out there perform it incorrectly and have no clue on how to interpret what they find. In case you missed it, CLICK HERE to read part one.

Today, however, I want to switch gears and talk a little about some of the corrective strategies one can implement after having completed the Thomas Test. Come on, you didn’t think I was just gonna leave you hanging like that did you?

Predictably, as I noted yesterday, pretty much everyone has a little sumthin, sumthin going on in their hip flexors, whether we’re talking poor tissue quality and/or limited length – no big surprises there. We sit…. a lot. We sit on our commute to work. We sit at work. We sit on our way home from work. We then sit some more at home. And, for most, we even sit while we “workout,” if you want to call it that. It’s no wonder our hip flexors are tighter than a crowbar!

But this is where the waters get a little murky and people start to miss the boat entirely. Simply put, while many are quick to just throw in a few mundane stretches into the mix – if they’re even stretching at all – it takes a little bit more than that to alleviate the problem.

As such, here’s the basic formula I like to use: release, stretch that mofo, then activate/mobilize.

Does the order matter? In my opinion, absolutely! When dealing with soft tissue restrictions, it’s important to break up any trigger points, adhesions or scar tissue first, because you can stretch till you’re blue in the face but you’re never going to get full extensibility/length of a muscle if it’s nothing but one massive knot in the first place.

Likewise, while it can be argued whether or not prolonged stretching actually stretches the muscle or just increase our tolerance to a stretch, the fact of the matter remails – it’s better than nothing; and, it undoubtedly makes people feel better afterwards. in addition, lenghtening the muscle allows us to “use” the new range of motion. It’s a win-win.

Don’t ne a Jonny Raincloud – just do it!

And finally, it makes sense that once any triggers points or knots are taken care of, we need to mobilize and/or activate the muscle to help engrain/cement the new ROM we’ve established.

Rectus Femoris:

In terms of self myfascial release, you need a foam roller. if you don’t have one, get one. They’re only $10 and there’s really no exciuse not to have one. No, really.

Having said that, the video below is a great place to start. While it demonstrates our entire foam rolling series, you can easily see how we hit the anterior surface of the thigh, which is where the RF is located.

From there, a few of my favorite exercises to mobilize the area are the yoga plex, and the wall hip flexor mobilization.

Perform 8-10 repetitions on each leg and you should be good to go. Just be cognizant NOT to hyper-extend your lower back while doing these.

In much the same light as the video above, when discussing the topic of stretching, it’s important to recognize that the RF crosses TWO joints (the hip and knee) and we need to take that into consideration. To that end, I really like the kneeling heel-to-butt stretch. Simply kneel on the floor, placing one foot behind you on a bench. From there, one important cue I like to give people is to squeeze the glute on the same side that’s kneeling. This “co-contraction” of the glute will posteriorly tilt the pelvis and allow for a more intense stretch of the RF. Hold for 30-60 seconds and switch to the other leg.

Psoas

The psoas is a bit tricker to get to in terms of SMR work, and as such, calls for modalities that are a bit more aggressive. Since the foam roller is virtrually useless in this case, I like to defer to the Thera Cane instead. Lie on your back with one leg flexed to 90 degrees. From here, I like to cue people to perform a teeny tiny crunch and feel for the lateral aspect of their rectus abdominus; then relax. Where you feel the muscle relax is where you want to “dig” the knob of the cane into. Hold it in place, and SLOWLY extend your leg until it’s completely straight. Try not to cry.

Essentially what you’re doing is a poor man’s version of Active Release Therapy, and to say that it’s a tad bit uncomfortable would be an understatement. Put another way: it f#@cking sucks, and I won’t think any less of you if you have to grab a Kleenex.

Perform 3-5 total passes on each side. Told ya, not fun.

In terms of activating the psoas, I like to use two exercise. The first is one that I got from Mike Boyle called the Seated Psoas Activation. Because the psoas is the one hip flexor that’s active above 90 degrees of hip flexion, it’s important that you find a low enough box to perform this exercise effectively.

All you’re going to do here is sit on the box with your back flush against a wall (so that you can’t lean back and cheat). Raise you foot off the ground and hold for 10-15 seconds. Lower it back to the ground and repeat the same sequence on the opposite side. Don’t be surprised if you can’t raise you’re foot that high – really, all we’re looking for are a couple of inches.

Another exercise I like is the lying psoas band march. Here, you’re going to lie supine (on your back) with a light band wrapped around both feet. Bring both knees up to 90 degrees of hip flexion and then extend ONE leg, keeping the other stationary at 90 degrees. The psoas is forced to fire by resisting the pull of the band (and staying above 90 degrees). Peform 8-10 repetitions on one side, then switch.

As far as dedicated stretches, I like the feet elevated warrior lunge stretch. Here, I like to note a few things:

1. You’re going to place one foot on a slight elevation (8-12 inches).

2. The leg that’s extended behind you is the side you’re stretching – much like the heel-to-butt stretch, be sure to squeeze the glute of that same side to posteriorly tilt the pelvis, which in turn, will elicit a more intense stretch.

3. Too, you want to reach up towards the ceiling with your arm and lean slightly in the opposite direction. So, if you’re right leg is extending behind you, you’ll reach up with your right hand and then lean slightly to the left. In all, it should look something like this:

Hold for a 30-60 second count and repeat on the opposite side.

TFL:

Okay, here’s the deal. In the process of writing this blog post, I accidentally deleted the ENTIRE thing and had to start from scratch.

FML!!!!

AFter throwing my face through a wall, I wrote the entire thing again (not quite as awesome as the first go round), and now I’m short on time, and the TFL is getting the shaft. Sorry.

Maybe I’ll throw a little tidbit in tomorrow, but for now, I really need to go lift something heavy to get this pent up aggression out. Hope this helps, and if anyone has anything to share, please feel free below!

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Killer content man! Thanks. I've also, found that with the heel-to-butt stretch, it helps to bring the toes of the back foot in towards the middle of your butt (or crack if you want to be technical). It tends to put a bit more stretch into the RF.

(ps. I promise not to be a douche on your blog today.)

R Smith

As usual, more content I can steal and apply immediately.

Steal sounds kinda harsh. How about appropriate?

Have a great day, guys.

RS

Ben

Tony if you soft tissue, activate, then stretch won't this work as inhibiting your hip flexors, which may be a good thing because you'll get more activation of the glutes. But I have learned that you go soft tissue, lengthen tissue, activate, and strengthen. But in the grand scheme of things if you have qualitity tissue and your hips aren't as tight as a crow bar all is good. So no argument at all. Nice job as usual.

Tony Gentilcore

@ Ben: oops – you're totally right. Like I said, I accidentally deleted the original post while writing it, so in my haste to re-write, I mixed a few things up

I went back and changed the order – thanks for the heads up!

Henock aka Nock

Tony, this is great stuff man. BTW…..I purchased the Foam Roller after seeing the stretching video a few months back on your blog and it has been one of the best moves I have made for my stretching routine. thanks again.

Matias

I love the Wall Hip Flexor Mobilization. I find that if I pull my foot all the way to my glute, it hits my RF more and if I let my foot fall behined it hits my HF more. I also like to push my stomach all the way out throughout the movement. This helps me keep my back straight.

http://physed93.blogspot.com/ TJ

Tony,

Great article, even if you had to write it for a second time. Foam rolling is crucial. Even though Mike T Nelson says get off the foam roller. Have you read much on arguments against foam rolling ? At the high school level with 35 students in a class, it is tough to foam roll or even have enough foam rollers for that matter. Any creative ways to deal with that? Also what about LARGE guys, I have a few offensive lineman that have a tough time getting in the position to foam roll. Obviously we are working on their mobility and dropping some dang pounds.

Thanks for posting, your articles are fun to read and very informative for a strength coach at the high school level.

http://www.benbruno.blogspot.com Ben Bruno

Great stuff Tony. I had never seen that Psoas release before but I am going to give it a rip (pun intended). I'm sure I'll be cussing you out when I do.

Dustin

Tony, thanks for sharing all of the great info. You and Eric put out great content and it is much appreciated.

With regards to the TFL, is there any concern about synergistic dominance with the lying band march? Also, with the band around the feet, could the direction of pull result in unwanted rotation at the hip? I could be way off here, but would appreciate your feedback.

Thanks again for your great work.

Ernie OMalley

That's the best article I've seen on this blog! Some knowledge bomb, Tony!

Really like the psoas-release though I think I need to practice it a bit to get it right.

This blogpost should get an award!

Tony Gentilcore

@ Dustin: Yes, there can definitely be some synergistic dominance going in holding that knee in knee flexion. The other alternative would be to keep both legs extended, and then just bring one knee up towards the chest, and repeat in that fashion (with a lighter band).

@ TJ: Yes, I've read and heard “some” of the arguments against foam rolling. Speaking truthfully, I don't buy it. I've seen waaaaaaaay too many people benefit from using the foam roller for me to just disregard it altogether.

Also, in terms of the larger guys: instead of the foam roller, you could try something like the Tiger Tail or The Stick.

Matt Biancuzzo

Great stuff Tony. Another option that I commonly use in my setting is to actually use the Thomas Test position as a stretch. Of course you need somebody to do the stretch and the table you used to perform the assessment.

Basically I put the person into the thomas test. I prefer to have the person fully relaxed and focus on some breathing patterns to elicit a better stretch, so I keep their flexed hip up by putting my chest/shoulder into the bottom of their foot instead of them pulling their knee to their chest. I then just press down on the thigh of the hip that is being tested. To increase the stretch more, I hook my leg in front of their lower leg to get them into a knee flexed position to get more quad/rectus femoris stretching. To get more TFL from this position, I will pull the thigh into more adduction and externally rotate the hip by pulling the lower leg medially.

It is a great position to do some PNF style stretching as well.

Tony Gentilcore

@ Matt: thanks for chiming in! I'm along the same lines as you, actually. If or when I do stretch clients, I'll use the same position and do some PNF type stretches, much like you described.

I think you’ve got me practically crying just looking at the psoas stretches!!! YOWZA!! I can’t wait to try them. I am new to lifting and my acupuncture doc told me that my tight psoas muscles are causing low back/pelvis pain. I have been looking for stretches to target the psoas that I can do on my own. Thanks for the great post!

TonyGentilcore

Well, stretching is just part of the equation, and I’d say stretching – at least what most people view it as – isn’t really going to do much.

Better yet, I’d look into seeking out a good manual therapist who can get his or her hands in there and “release” it. From there, it’s important to cement that new length with strength – mobility exercises, etc.

CodieD

Thank you for the suggestions! You rock. End of story.

I just discovered GWOD. I will be trying some of those plans for sure. The tips on warming up are SUPER helpful!

My acupuncture doc actually stuck a really long needle on each side in the spot that you used during the cane release above (also not very comfortable) and some in my glutes. It’s supposed to stop the spasms/release it. I am sure it’s not exactly the same as having someone get in there with their hands, but it sure helped relax things a lot! It’s pretty amazing how quickly my muscles react to acupuncture.

TonyGentilcore

So long as it helped and you found relief, that’s all that matters…..;o)

YES, definitely check out GWOD and let me know what you think!

CodieD

Went to the MPT yesterday. GLAD I did. One side of my pelvis is tipped forwards, the other side backwards and I have a bad anterior pelvis tilt on top of that. I guess the SI joint on one side is funky too. I have lots of work to do Glad you suggested the MPT. She explained all the muscle stiffness I have had for months. I have imbalances to correct for sure!